Reducing Severe Tracheal Intubation Events Through an Individualized Airway Bundle

Area of Science:

• Neonatal critical care
• Pediatric airway management
• Quality improvement science

Background:

• Neonatal tracheal intubation (TI) is a high-risk procedure with potential adverse safety events.
• Neonatal intensive care units (NICUs) track tracheal intubation-associated events (TIAEs) through registries like the National Emergency Airway Registry for Neonates.
• The study aimed to reduce overall TIAEs by 10% within 12 months.

Purpose of the Study:

• To decrease the incidence of adverse events associated with neonatal tracheal intubation.
• To implement and evaluate an Airway Bundle (AB) as a quality improvement strategy.
• To improve patient safety during neonatal intubation procedures.

Main Methods:

• A quality improvement team developed an individualized Airway Bundle (AB) for high-risk neonatal intubations.
• Plan-do-study-act cycles were used, including simulation, education, and iterative adjustments to the AB.
• Outcome measures included TIAEs (overall and severe), with process measures for AB initiation, video laryngoscope (VL) use, and paralytic use.

Main Results:

• The severe TIAE rate decreased significantly from 0.047 to 0.016 per intubation encounter.
• Airway Bundle initiation improved from 70% to 90%, and its use at intubation increased from 18% to 55%.
• Video laryngoscope use improved from 86% to 97%, with no significant change in paralytic use.

Conclusions:

• Implementation of the Airway Bundle led to a significant reduction in severe TIAEs in neonates.
• The study highlights the effectiveness of a structured approach and quality improvement methods in enhancing neonatal airway safety.
• Future efforts will focus on increasing the consistent use of the Airway Bundle during intubations.